Provider Demographics
NPI:1619684990
Name:BURROUS, TERESA (ASST IN SLP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:BURROUS
Suffix:
Gender:F
Credentials:ASST IN SLP
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:HENDRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:144 CHARLIE HALL RD
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-1089
Mailing Address - Country:US
Mailing Address - Phone:936-707-6948
Mailing Address - Fax:
Practice Address - Street 1:144 CHARLIE HALL RD
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-1089
Practice Address - Country:US
Practice Address - Phone:936-707-6948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX308872355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX30887OtherTEXAS DEPT OF LICENSING & REGULATION